Individual provider Active NPI

Mahmoud Farhat, PA-C

  • Physician Assistant
  • McHenry, IL
National Provider Identifier
1922785310
Registry record updated Aug 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085010446 Issued in IL
Practice address
4309 W Medical Center Dr Ste A200
McHenry, IL 60050-8437
Phone
(815) 759-8070
Fax
(815) 759-4931
NPI assigned
Jun 28, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 14, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X 5601011868 MI
Surgical Physician Assistant 363AS0400X IL
Physician Assistant 363A00000X 085010446 IL Primary

Addresses

Primary practice location

4309 W Medical Center Dr Ste A200
McHenry, IL 60050-8437

Mailing address

4309 W Medical Center Dr Ste A200
McHenry, IL 60050-8437
Phone (815) 759-8070

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240904003229 IL Practitioner - Physician Assistant 8224482112 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4201 W Medical Ctr Dr
McHenry, IL 60050-8409
Phone (815) 759-4323

515 Valley View Dr
Suite 201
Moline, IL 61265-6175
Phone (312) 695-0870

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085010446ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group CurrentSince Jul 1, 2024 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jun 24, 2025 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jun 24, 2025 Accepting new patients
St Joseph Mercy Hospital Past Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

2151 Waukegan Rd
Bannockburn, IL 60015
Phone (847) 236-1300

Dept 5777
Carol Stream, IL 60122

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

10370 Haligus Rd
Ste 200
Huntley, IL 60142
Phone (815) 759-8070

660 N Westmoreland Rd
Lake Forest, IL 60045
Phone (847) 535-6100

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

4309 W Medical Center Dr
Ste A200
McHenry, IL 60050
Phone (815) 759-4699

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

Interoperability endpoints

  • Direct secure messaging: mfarhat2890571@direct.trinity-health.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755129600000",
    "number": "1922785310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE A200",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508437",
            "telephone_number": "815-759-8070",
            "fax_number": "815-759-4931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR STE A200",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508437",
            "telephone_number": "815-759-8070",
            "fax_number": "815-759-4931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARHAT",
        "first_name": "MAHMOUD",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-28",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MI",
            "license": "5601011868",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085010446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

Verify at the official NPI Registry.